Barriers to Participation in the National School Lunch Program As Perceived by School Nutrition Staff and Managers, Students and Students' Parents Open Access

Abstract

Obesity is a growing public health issue both internationally and domestically, and children who are overweight or obese are more likely to become obese adults (WHO, 2015; Guo et al., 1999; Freedman et al., 2005; Freedman et al., 2009; Freedman et al., 2001). The Healthy, Hunger-Free Kids Act of 2010 seeks to reduce childhood obesity and improve the diets of children through a number of prevention-based interventions, many of which are implemented through the National School Lunch Program (NSLP), yet nationwide participation in NSLP declined by 1.2 million students in the first two years after the act was introduced (Healthy, Hunger-Free Kids Act of 2010, 2010), (GAO, 2014). In order to inform development of NSLP based interventions to reduce and prevent childhood overweight and obesity, this study sought to identify and understand barriers to participation in NSLP from the perspectives of school nutrition program employees, students, and parents. Data were collected through eight focus group discussions of five to seven participants and analyzed through the process of thematic analysis. The study population were of schools in middle income suburban communities in the Atlanta area. Results showed several barriers related through a central theme of food dissatisfaction. Students and parents shared decision power in the choice of whether or not to purchase school lunch. Students were more likely to choose whichever option best met their taste preferences, while parents' decision processes were more complicated, with convenience and their children's food preferences acting as influencing factors towards participation barriers. Although staff and managers felt many issues affecting school food satisfaction were out of their control, i.e. strict regulations and budget limitations, some have found ways to work within such constraints through creative food seasoning and grant funding for fresh local produce. Results suggest that schools may be able to improve participation in their own programs through use of these alternative solutions.

Table of Contents

I. Introduction - 1

a. Definition of Terms - 5

II. Review of Literature - 6

III. Manuscript - 15

a. Introduction - 18

b. Methods - 21

c. Results - 26

d. Discussion - 35

e. References - 41

f. Tables and Figures - 43

IV. Conclusions and Recommendations - 45

V. References - 46

About this Master's Thesis

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School	Rollins School of Public Health
Department	Hubert Department of Global Health
Degree	MPH
Submission	Master's Thesis
Language	English
Research Field	Health Sciences, Nutrition Health Sciences, Public Health
Keyword	Childhood Obesity National School Lunch Program School Nutrition Focus Groups
Committee Chair / Thesis Advisor	Hennink, Monique, Emory University
Committee Members	Welsh, Jean A., Emory University
Partnering Agencies	Hospital or other health care provider

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